Indoor and Outdoor Relief
A Report of the Committee by F. B. Sanborn, Chairman, at the Seventeenth Annual Session of the
National Conference of Charities And Correction, 1890
At what precise time these terms came into use — Indoor Relief and Outdoor Relief–we cannot say; but they sprang up in England long ago, and were used to signify relief given to the public poor inside the parish workhouse, as distinguished from relief given to the same class outside the workhouse. Now, the whole universe could surely be divided into two (very unequal) parts; namely, the inside of the parish workhouse (at Barton-Regis, for instance) and all the rest of the world outside of that little edifice. Consequently, so far as the Guardians of the Poor in that parish were concerned, all aid given to their beneficiaries, except within their workhouse, was technically Outdoor Relief. But, then, they might be supporting insane persons in a county asylum, sick persons in one or more hospitals, blind and deaf persons in special schools, and others of the public poor in other places where they would be subject to restraint and discipline, perhaps as careful as that given in the parish workhouse; and the expense of the support of these different classes might be as strictly under the eye of public officers as if it were paid in the workhouse itself. There was and is, however, another class of public poor, who perhaps never enter a public establishment of any kind to reside there, but, when they receive aid from the Guardians of Barton-Regis, or any other functionaries, receive it either in money or food, or clothing, or tickets of some kind, or in some other mode coming under the general description of what the French call “Family Aid” (Secours d Domicile). Not that every one of the persons so aided, even in France, has, in fact, a domicile or a family; but he may profess to have them, and, at any rate, he is not inside of any public establishment.
It is this last class of persons, having nominally, at least, a home, and perhaps persons dependent upon them, to whom, as we use the term in America, the phrase “Outdoor Relief” really applies; and this class is much smaller than would usually appear from the account of expenditure for outdoor relief in our official reports. For example, the State of Massachusetts has among its State Departments, drawing money from the State Treasury, one officially styled “The Department of Outdoor Poor”; and this department in the year ending Oct. 1, 1889, expended for all purposes about $110,000. It might be said, therefore, if one looked at names rather than things, that the State of Massachusetts was expending more than $100,000 a year for outdoor relief. But, in fact, nearly $26,000 of this sum was paid for the support of sick persons in a single hospital (the Boston City Hospital); and not less than $20,000 more was paid for the support of persons in other hospitals, in city and town almshouses, and in the Massachusetts Infant Asylum. There was also expended for burials (which might be reckoned a kind of outdoor relief, since they usually took place in the open air) $6,500; and a considerable sum was paid for the transportation of poor persons from one place to another. Making these deductions, the sum expended by Massachusetts for family aid, or outdoor relief, as we understand it, would fall from $110,000 to less than $50,000, not reckoning the salaries of the officers who carried on the department. These amounted, together with their travelling expenses, to nearly $18,000.
This will be a sufficient illustration of what is meant when we say that the reported outlay for aid to the poor in their own families is often much greater than the sum actually expended. A classification different from that of the English has sometimes been adopted, dividing the poor into persons fully supported and persons partially supported during the year. This classification, however, is hardly more exact than the terms of which we are speaking; for so many poor persons, including children and the harmless insane, have of late years been boarded in families that the money expended for full support would in many cases go to the heads of families, while the persons paid for might not be inside any public establishment during the whole year. Moreover, a difficult question arises as to what “full support” shall be. Shall a person who has been in an almshouse three days, or three weeks, be entered as fully supported? In other words, how long a period of support should be designated by the term “full support”? In Massachusetts we generally reckon all persons as fully supported who have been in an almshouse for a week. But many of these same persons will also have been aided outside the almshouse, and in the families of themselves or other persons, at other times, during the year for which the report is made. So that the number of persons fully supported, when added to the number of those partially supported or aided, will always give too large an aggregate, in case the number of such class has been correctly counted, because there will be many who are reckoned in both classes.
It will thus be seen that, whether we speak of the whole expense of family aid (outdoor relief) or of the whole number who receive it, we cannot be sure that the official figures give us any accurate statement under either head. If it should be declared, for instance, that the number of persons receiving outdoor relief in Massachusetts last year was 48,123, as shown by returns from the towns and cities, or if we add 20,000 to this number for those aided in some way by the State Department of outdoor poor, it is not even probable that these are the correct figures. They can be only an approximation in any case, because there are so many duplications and omissions.
The tables of the United States Census do not give even an approximation to the statistical truth concerning the aggregate of the public poor, and their classification as to methods of relief. Thus the census of 1880 gave the whole number of the indoor and outdoor poor of Massachusetts on a given day (June 1, 1880) as only 5,423, of whom only 954 were outdoor paupers: whereas, by official State returns, much more exact than those of the census, there were one month later (July 1, 1880) at least 12,000 outdoor paupers receiving aid on that day, or more than a dozen times as many as the census enumerators reported. This number (12,000) is below the average of the outdoor poor in Massachusetts for ten years past, as shown by the careful State census taken twice a year by the State Board of Charity. And be it observed that, though we can only approximate to the whole number of different persons who in a year receive public aid in some form, we can obtain an average of their number at any given time with much exactness. Thus we know that in Massachusetts during the ten years ending April 1, 1889, the average number of persons partially supported, by what is commonly called outdoor relief, was at least 16,000; while the average number fully supported (mostly by indoor relief) has been less than 8,000. Yet the cost of maintaining the 8,000 persons has been more than $1,000,000 annually, while the cost of supporting the 16,000 outdoor paupers has been less than $650,000 annually. The average annual cost of each outdoor pauper, or recipient of family aid, was less than $40 for a year of 52 weeks, while the average yearly cost of each indoor pauper was more than $139; and, if interest on the value of the almshouses, asylums, etc., where the indoor poor lived, were added, their yearly cost would go up to $180 at least, or four and one-half times as much as the cost of the outdoor poor.
Here we see one reason why outdoor relief is everywhere and always more common than indoor relief, –for the same sum of money a much greater number of the poor can be aided. But another cogent reason is that there never has been anywhere, and perhaps never will be, almshouses, workhouses, hospitals, and other places of indoor relief in sufficient number to contain all the poor at any season, or half of them in seasons of special destitution. Outdoor relief has, therefore, always existed, as the Tennessee lawyer observed in another connection, “from the ex necessitate rei of the thing.” It would be idle to expect the farmer to barrel all his apples if he could only find barrels enough for half of them; and it is equally unreasonable to expect a community to put all its paupers into public buildings, if there is room in those buildings for less than a third part of them, which is the fact.
The “workhouse test,” as it used to be called in England, by which a poor man was compelled either to go to the workhouse or go without public relief altogether, cannot be applied in these modern times very strictly for another reason. Not only are there not workhouses enough to hold them, if all should go, but there are whole classes for whom it would be a bad place. It would be bad for children, for the insane in general, for idiotic women, for the sick who require nourishing and stimulating treatment, for the blind and the deaf, for the epileptics, and so on. Establishments for these special classes, and many more, have sprung up, where a hundred years ago only the workhouse or almshouse could be found. Perhaps we do not realize how large a part of our public poor are insane, and that this part is increasing faster than any other. Among 10,525 paupers fully supported in Massachusetts in 1888 (January), 4,316 were insane; and out of 10,453 in July, 1889, 4,709 were insane. The proportion of the insane to the sane poor is here about as four to five; while twenty-five years ago it was much less than this. If all the idiotic and mentally defective poor were added to the insane, the whole number in Massachusetts would be found quite equal to that of the sane poor who are fully supported. But, of those partially supported, the largest number are children; and comparatively few of them are insane or idiotic.
Of course the insane poor generally require a more costly treatment than sane persons, except those suffering with severe physical disease. Indeed, the rate of cost for the ten or fifteen distinct classes into which the poor who are fully supported may be divided varies so much that it is hardly possible to fix a uniform rate for their support. Nor, if it were feasible, would it be desirable; for some of these classes require costly training, others require costly nursing, while others, if properly supervised, are almost self-supporting. That mythical class, the “able-bodied poor,” are scarcely found in this country in public establishments, except for a few months in the cold season, when the number of employments, both for men and women, is considerably reduced by Nature herself.
Until recently, in the English-speaking countries, it was believed that the insane, whether rich or poor, could only be cared for properly in special establishments, which therefore were provided in great and increasing number in every civilized community of dense population. But the method of family aid (outdoor relief) has been found applicable, and very beneficial, to a large class of the insane in Scotland, where they are boarded in families to the number of two thousand or upwards. The same method had long before been adopted in Belgium, and five years ago was introduced by statute in Massachusetts, where a small number of the insane are now boarding in rural families (but sometimes in cities), with much comfort to themselves, and oftentimes a considerable improvement in their mental condition. It is also becoming more and more the practice in New England, and perhaps elsewhere, to treat recent insanity in families, under medical care, rather than to send the patients to a great asylum, where forced association with many other insane persons may do them as much harm as good.
Nevertheless, the insane, whether rich or poor, must generally be maintained in public establishments, and the method in use for those who are paupers must be that of indoor relief. But it will be found, we suspect, that many of the charges made and reported in the United States as outdoor relief were really incurred for the indoor support of insane persons in asylums, children in county homes, young offenders in reformatories, and others who really belong to the indoor class, but for special reasons have the outlay for them mixed up with the general expenses of outdoor relief. This has certainly been the case in Massachusetts, as it was for many years in England.
Until within a few years, it has not been customary in England to reckon the insane poor in county asylums as subjects of indoor relief; but their cost, amounting to many hundred thousand pounds, was included in the reported expenditure for outdoor relief. Yet no class of the poor was more strictly indoor, or more fully supported without family aid, than these insane paupers. In regard to other classes of the English poor, Mr. Goschen, the eminent statesman, when president of the old poor-law board, twenty years ago, said: “It cannot be denied that the more humane views which have prevailed during the last few years, as to the treatment of the sick poor, have added most materially to poor-law expenditures. Workhouses, originally designed mainly as a test for the able-bodied, have, especially in the large towns, been of necessity gradually transformed into infirmaries for the sick; and the higher standard for hospital accommodations has had a material effect upon the expenditures.” The process here mentioned by Mr. Goschen has gone on still more rapidly, in Great Britain and everywhere else, since 1870, and in the natural course of events will go on indefinitely. For it is found that the greatest success in dealing with the poor is obtained by classifying them according to their real character and needs, and not by herding them together in a common receptacle for all forms of poverty.
In making the broad, general distinction between two main classes of the public poor, it would seem to be natural and proper to begin with that class which has not been withdrawn from the natural home of all mankind,–the family. There are persons, be the number greater or less, who need public relief at their own homes, and who can receive it there with greater advantage both to themselves and to the public than anywhere else. Oftentimes these are persons who have a little property, which would be sacrificed or diminished in value if they were removed, even for six weeks, to an almshouse, hospital, or insane asylum. Concerning this class of persons, that excellent economist, the younger Pitt, said in Parliament, in 1796: “The law which prohibits giving relief where any visible property remains should be abolished. That degrading condition should be withdrawn. No temporary occasion should force a British subject to part with the last shilling of his little capital, and to descend to a state of wretchedness from which he could never recover, merely that he might be entitled to a casual supply.” What Mr. Pitt said concerning a British subject is none the less true when applied to free American citizens. Great care should be taken, in relieving their distresses, not to throw them into the great class of vagrant and homeless poor, to which belong many of the inmates of our public establishments, when they go forth from an almshouse, a hospital, an insane asylum, or a prison, into the general community.
Let us, then, adopt as the starting-point of our system of public charities what the French call Secours a Domicile, and what we have termed “Family” or “Household Aid.” The family in question may be that of the poor person himself, or it may be some family into which he has been adopted as child or boarder. Make the number of these family cases as small as you please, but let it be, as by the great law of nature it must be, the initial point of public charity.
Starting, then, from this focus of the family, let the scheme of indoor relief be laid down on a broader scale than has been done theoretically, in England, until very recently; and let it be a scheme capable, as it should be, of indefinite expansion, as civilization advances. By the old “workhouse test,” a dozen classes of the public poor were thrown together, higgledy-piggledy, in the great wards of the old-fashioned poorhouse. The healthy infant, the diseased foundling, the children of school age, the idiotic and sickly children, deaf and blind children, epileptics, the maimed and deformed, sick persons of all age, and every variety of disease, from the most transient to the most chronic, loathsome, and contagious; idiots and insane persons, tramps, rogues, prostitutes, pickpockets, vagrants of every class, professional beggars, impostors of all kinds,– these, and other varieties of the wretched, the fraudulent, and the vicious, were brought together, with more or less separation according to sex and age, in the same building that sheltered the aged poor, who had been all their lives honest and respectable, and would support themselves, if they could, wherever placed. One reason why family aid has been carried, especially in cities, to such an extent as to prove an abuse — and sometimes a very great abuse — was the desire to prevent the breaking up of families, the corruption of the young, and the unspeakable distress of the old and the virtuous, by throwing them into forced association with the dregs of mankind, in what was ironically termed a charitable establishment. Indoor relief can never be what it should be until separate provision, on a reasonable scale, is made for all the main classes of the distressed, helpless, and vicious poor.
The ancient fallacy concerning outdoor relief, then, was to suppose that the workhouse and its immediate adjuncts could be made, under ordinary circumstances, to receive all the cases of poverty which might otherwise be provided for in families. The modern fallacy is not to take notice of the obvious fact that indoor relief, as we now practice it, is an indefinite extension, in a much better mode, of the old workhouse facilities for restraining, disciplining, and aiding the poor. So far as experience can teach anything, it teaches us that both indoor relief (in its extended form) and family aid, or outdoor relief, as properly practiced, are both indispensable in any comprehensive plan of public charity. Wherever and whenever one of these methods has been wholly given up, accidentally or purposely, evils have followed which only the introduction of the omitted method could wholly remove. Where to draw the line between the practical use of the two methods, for individual cases of poverty, is a matter only to be determined by wise discretion on the part of the officers who administer public relief. Indoor relief will generally be found more costly in proportion to the number relieved than family aid; and it will also, in general, apply to a much smaller number of cases, but, so far as it can be rationally and humanely used, it should be made to cover as many cases as possible. Family aid, on the other hand, should be restricted as much as possible, except for classes of the poor to whom indoor relief is (presently or prospectively) likely to be injurious. The public, generally, prefer, for reasons of sentiment, and oftentimes of good sense, the use of family aid rather than the separation of households and the sequestration of persons in great establishments, where individuality is lost in the mass, and persons are known by a numeral rather than a proper name.
Source: Proceedings of the National Conference of Charities And Correction at the Seventeenth Annual Session in Baltimore, Md., May 14-21, 1890. Pp.73-81.
http://quod.lib.umich.edu/n/ncosw/ach8650.1890.001/5?view=image&size=100 (Accessed: October 11, 2014).